Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: We concur with Drs Kario and Pickering.
Had the upper threshold of our target range of self-measured diastolic BP
been less than 85 mm Hg, we might have achieved similar levels of blood pressure
control in patients randomized to treatment based on self-measured BP compared
with those treated based on office BP. However, this statement must be taken
in the context of 3 important considerations.
First, we intentionally kept our target range of diastolic BP identical
in randomized groups to allow blinded treatment decisions and direct comparison
of our current results with those from our previous work.1 Second,
use of lower BP targets for treatment based on self-measured BP or daytime
ambulatory BP would have substantially altered the prevalence of white-coat
hypertension. For instance, at baseline in our current trial (n = 400), the
numbers of patients with white-coat hypertension were 107 (26.7%), 58 (14.5%),
and 20 (5.0%) if the systolic/diastolic diagnostic thresholds of self-measured
BP were set at 140/90 mm Hg, 135/85 mm Hg, or 130/80 mm Hg, respectively.
In the 2 studies combined (n = 803), the same levels for the daytime ambulatory
BP identified 158 (19.7%), 82 (10.2%), and 30 (3.7%) patients as white-coat
reactors. Use of lower thresholds to fine-tune antihypertensive drug treatment
based on automated techniques of BP measurement implies that fewer patients
would discontinue therapy and that more would proceed to multiple drug regimens
than we reported.
Staessen JA, Den Hond E, O'Brien ET. Guidelines for Home- and Office-Based Blood Pressure Monitoring—Reply. JAMA. 2004;291(19):2315. doi:10.1001/jama.291.19.2315-b